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Figure 1 Technique of fenestrating an extracardiac conduit Fontan with an expanded polytetrafluoroethylene tube graft. (A) After completion of the Fontan conduit anastomoses, partial occlusion vascular clamps are placed on the medial aspect of the conduit and across the tip of the right atrial appendage. Incisions are made for anastomosis of the fenestration tube, as indicated by the dashed lines. (B) The fenestration tube (4 to 8 mm expanded polytetrafluoroethylene vascular tube graft) is anastomosed to the incisions in the conduit and the right atrium, using continuous 5-0 polypropylene suture.